Ticket for Outdoor Patient
| Ward No. 2 | U-PHC No. | Registration No. 04269 | Date 18/03/2019 |
| Token No | SM/18-19/11313 27/03/2019 | Serial | 017 Last Visit: 27/03/2019 |
| Patient Name | Mrs. KAKULI PAIN | Contact No | 7685001733 |
| Address | 55 CHATRA BARUI PARA LANE SERAMPORE | Age | 42 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 65 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||